How the world can cut malaria cases by 90% in the next 15 years

Collins Ouma, Maseno University

With more than 200 million cases recorded across the globe each year and half the world’s population living in areas considered high risk, malaria remains a challenge.

Malaria occurs mostly in poor, tropical and sub-tropical areas. It is transmitted by an infected mosquito. In the human body, the parasites multiply in the liver and then infect red blood cells.

In 2012, there was estimated 207 million malaria cases, resulting in 627,000 deaths. About 90% of the deaths were in sub-Saharan Africa.

But over the next 15 years, the number of malaria cases and deaths could be reduced by up to 90% if the agenda of the World Health Organisation and the Roll Back Malaria partnership is fully implemented.

Central to their approach is the global technical strategy for malaria, created by the organisation, and a parallel advocacy plan. Created by the partnership, this involves action and investment to defeat malaria between 2016 and 2030.
The partnership, made up of several international organisations, will build on the successes of its global malaria action plan, a strategy developed in 2008. The plan was developed through an intensive consultation with 30 endemic countries and regions, 65 international institutions and 250 experts.

Their new plan comes as the World Health Organisation disbands and restructures the Roll Back Malaria secretariat to meet the new challenges posed in the post-2015 era.

The disbandment brings uncertainty about whether the global malaria action plan will remain the focus of the new team. For the new strategy to be sustainable, it would need to heed some of the 1998 action plan’s success.

A successful campaign

The action plan became the most prominent malaria strategy, providing a global framework for action used by partners to co-ordinate their efforts.

It gave malaria-affected communities a roadmap for progress and an evidence-based strategy to deliver effective prevention and treatment. It also gave funders estimates of the annual requirements to reach the global targets. This includes universal coverage of preventive interventions and access to effective treatments.

To date, more than six million malaria-related deaths, mostly children under five years, have been reduced. Part of this has happened by using preventive therapies for infants and children along with insecticide-treated nets, indoor residual spraying and rapid diagnostic tests. At the same time, malaria-related mortality has decreased by 58%.

More than 100 endemic countries are now malaria-free, including Azerbaijan and Sri Lanka. A further 55 countries are on track to reducing malaria incidence rates by 75% by the end of 2015.

Both the Millennium Development Goal malaria target and the World Health Assembly target of reducing the global malaria burden by 75% by the end of 2015 have been met.

These achievements have been made against the backdrop of less effective health systems in African countries.

There are several factors that explain the success in reducing the burden of malaria. These include:

increased international and domestic financing;
political commitment and strong country leadership;
multi-sectoral partnerships and technical knowledge;
effective execution of national programmes;
the involvement of civil society and faith-based organisations; and
contributions from research.

Collectively, these factors resulted in various cost-effective interventions being upscaled, including:

long-lasting insecticide-treated nets;
indoor residual spraying;
rapid diagnostic tests;
artemisinin-based combination therapies; and
intermittent preventive treatment during pregnancy.

The new plan

A critical part of the new strategy and advocacy plan is that it anticipates the changes and increased resources that are needed to combat malaria.

It also factors in the partnership’s needs to expand its engagement beyond its traditional partners. This may entail other sectors affected by malaria contributing to reduce and eliminate the disease. This could be through support in procurement and supply management, surveillance, and collaboration between public and private health providers. To date, these have brought wider benefits to health systems in the fight against malaria.

To date, the Roll Back Malaria campaign’s global investments in the fight against malaria have grown by 2000% from US$130 million to US$2.7 billion annually.

While the World Health Organisation’s strategy lays out the key goals and targets for 2030, the advocacy plan describes the actions and investments needed to achieve those goals.

The plan projects a 90% reduction by 2030 in malaria mortality rates and cases compared to 2015. It also seeks to eliminate malaria from 35 more countries and prevent its re-emergence of in countries where it has been eliminated.

Moving forward

As the millennium development goal era comes to an end, it will be critical for the new Roll Back Malaria Secretariat to place malaria high on its political, social and financing platforms.

The World Health Organisation is committed to fulfil its role. But what’s critical is that it accelerates the appointment of relevant experts. This will support much needed initiatives that will help achieve action plan targets. It is especially important as the action plan teams gear towards harnessing global funding. The aim is to triple it from the current levels.

There is a worldwide expectation that new structures will be put in place to engage key stakeholders, mobilise global action and generate the required financial commitments to move towards the 2030 goal of cutting the malaria caseload by 90%.

Collins Ouma, Program Head of Health Challenges and Systems at African Population and Health Research Centre, Maseno University

This article was originally published on The Conversation. Read the original article.

Pregnancy diabetes is a red flashing light that we can’t ignore

Josie Evans, University of Stirling

Most people are well aware of two of the main forms of diabetes – type 1, which usually first appears in young people; and the more common type 2, which often emerges in the over 40s and is associated with obesity and sedentary lifestyles. We hear far less about the third form, gestational diabetes, which temporarily affects as many as 16% of pregnant women.

Gestational diabetes is defined as glucose intolerance that is first diagnosed during pregnancy. Women with gestational diabetes are unable to produce enough insulin to meet the extra demands of carrying a child, the risk of which increases with each successive pregnancy. For the majority of them, the condition is diagnosed during the second or third trimester. Many of the risk factors, such as age, obesity and family history, are the same as those for type 2 diabetes. And, just like type 2 diabetes, many countries have seen prevalence rates rise over the past few decades.

Risky business

Most women with gestational diabetes return to normal glucose tolerance after delivery, but there are immediate risks for both mother and baby. These include spontaneous pre-term labour, delivering a large baby, infant respiratory distress syndrome and heart muscle diseases.

But gestational diabetes is also associated with an increased risk of developing type 2 diabetes in later life: seven times that of the general population. This equates to a staggering 50% chance of developing type 2 diabetes within ten years. The children of women who have had gestational diabetes are also six times more at risk of developing type 2 diabetes as the general population.

Women with gestational diabetes are not unaware of these risks. Claire Eades, a University of Stirling researcher, recently interviewed some Scottish women who had had the condition. At the time of diagnosis, most had worried about the possible side effects to the baby, and talked graphically about their fears of delivering a big baby. Some changed their lifestyles during pregnancy as a result.

The women usually also knew their increased risk of type 2 diabetes, having been told by their healthcare professionals. But once they had delivered a healthy baby and returned to normal glucose tolerance, many quickly forgot. One compared gestational diabetes to maternity clothes – put away and forgotten until the next pregnancy.

Healthy baby, why worry?
LiAndStudio

The case for action

Since the risks of type 2 diabetes can be reduced by taking more exercise, a healthy diet and maintaining a healthy weight, we need to find ways to encourage this where it is needed. The later stages of pregnancy and early stages of motherhood are hardly the best time when women are dealing with big life changes and pressing demands on time and energy.

To date, there have been few attempts to measure which kinds of interventions are best to encourage women to take the best steps – which possibly reflects the scale of the challenge. There is some evidence that women are more likely to respond positively if the interventions include face-to-face interaction either with peers or professionals, if their partners are involved, and if the women are offered childcare support. We’ve been asking women who have had gestational diabetes about what they think would be the best kinds of interventions to try out.

We probably also need to remind women of the increased risk of type 2 diabetes more regularly once the early-motherhood period has passed. It is therefore time to think about raising the profile of gestational diabetes across the whole population. It offers a big opportunity to gain ground in the fight against diabetes. World diabetes rates are set to rise 50% to nearly 600m by 2035 – and the disease has been described as a global pandemic. So long as gestational diabetes is out of sight and out of mind except during pregnancy, we won’t be able to use it to make people aware of the importance of a healthy lifestyle and to prevent more cases of type 2. Instead, it offers a big opportunity to gain ground in the fight against diabetes.

Josie Evans, Reader in Public Health, University of Stirling

This article was originally published on The Conversation. Read the original article.

Why sleep could be the key to tackling mental illness

Russell Foster, University of Oxford

We are only beginning to unravel the genetic and biochemical basis of mental illness – a vague term including conditions as diverse as anxiety, depression, and mood and psychotic disorders. With millions of people suffering from such conditions, it is crucial that we find ways to improve diagnosis and treatment. But an increasing body of scientific evidence is now suggesting that we should turn our attention to one of our most basic functions: sleep.

Studies suggest that disrupted sleep such as insomnia could actually help us predict episodes of mental illness and that fixing sleep problems may help treat them. Despite this, the effects of sleep on mental illness have been largely ignored in the clinic so far. But how is sleep and mental health actually linked in the brain? To understand this, let us first consider the biology of sleep and circadian rhythms.

Circadian rhythm and health

There have been over a trillion dawns and dusks since life began some 3.8 billion years ago. The physiology, metabolism and behaviour of organisms, including us, are aligned to this daily cycle through internal clocks which enable us to effectively “know” the time of day. This clock also stops everything happening at the same time and ensures that biological processes occur in the appropriate order. For cells to function properly they need the right materials in the right place at the right time.

Thousands of genes have to be switched on and off in order and in concert. Proteins, enzymes, fats, hormones and other compounds have to be absorbed, broken down, metabolised and produced in a precise time window to allow important processes such as growth, reproduction, metabolism, and cellular repair. These take energy and all have to be timed to best effect by the millisecond, second, minute and hour of the 24-hour day.

Why do we sleep and what happens if we don’t.

Circadian rhythms are innate and hard-wired into the genomes of just about every living thing on the planet. In humans, our physiology is organised around the daily cycle of activity and sleep. In the active phase, when energy expenditure is high and food and water are consumed, organs need to be prepared for the intake, processing and uptake of nutrients.

During sleep, although energy expenditure and digestive processes decrease, many essential activities occur including cellular repair, toxin clearance, memory consolidation and information processing by the brain.

Disrupted sleep and circadian rhythm can have major impact on emotion, cognition and physical health.
Author provided

Disrupting this pattern, as happens with jet-lag, shiftwork, and mental illness breaks down the internal synchronisation of the circadian network and our ability to do the right thing at the right time is greatly impaired. This can have a major impact on our health, with some of the effects described in the table above.

Sleep disruption in mental illness

The relationship between mental illness and sleep and circadian rhythm disruption was first described in the late 19th century by the German psychiatrist Emil Kraepelin. Today, such disruption is reported in as many as 80% of patients with schizophrenia, and is increasingly recognised as one of the most common features of the disorder.

Yet despite its prevalence in mental illness, sleep disruption has been largely ignored, dismissed as a consequence of either social isolation, lack of employment, anti-psychotic medication. However, our team has explored this assumption and showed that sleep and circadian-rhythm disruption in patients with conditions such as schizophrenia persists independently of anti-psychotic medication and that it cannot be explained on the basis of social isolation or lack of employment. These results led us to suggest that mental illness and sleep disruption may share common and overlapping pathways in the brain.

The sleep and circadian timing system is the product of a complex interaction between multiple brain regions, neurotransmitters and hormones. As a consequence, abnormalities in any of these neurotransmitter systems will likely have an impact on sleep and circadian timing at several levels.

Similarly, psychiatric illness arises from abnormalities in the interacting circuits and neurotransmitter systems of the brain, many of which will overlap with those regulating sleep and circadian rhythms. Viewed in this way, it is no surprise that sleep disruption is common across the mental illness spectrum, or that disruption of circadian biology might worsen a fragile mental health state. Very significantly, many of the health problems caused by sleep disruption are common in mental illness, but have almost never been directly linked to the disruption of sleep.

These insights enable us to make important predictions. For example, genes linked to mental illness should play a role in sleep and circadian rhythm generation and regulation and genes that generate and regulate sleep and circadian rhythms should play a role in mental health and illness.

To date a surprisingly large number of genes have been identified that play an important role in both sleep disruption and mental illness. And if the mental illness is not causing disruption in sleep and circadian rhythm, then sleep disruption may actually occur just before an episode of mental illness under some circumstances.

Sleep abnormalities have indeed been identified in individuals prior to mental illness. For example we know that sleep disruption usually happens before an episode of depression. Furthermore, individuals identified as “at risk” of developing bipolar disorder and childhood-onset schizophrenia typically show problems with sleep before any clinical diagnosis of illness.

Such findings raise the possibility that sleep and circadian rhythm disruption may be an important factor in the early diagnosis of individuals with mental illness. This is hugely important, as early diagnosis offers the possibility of early help. It is also plausible that treating the actual sleep problems will have a positive impact upon the level of mental illness. A recent study managed to reduce sleep disruptions using cognitive behavioural therapy in patients with schizophrenia who showed persecutory delusions and found that a better night’s sleep was associated with a decrease in paranoid thinking along with a reduction in anxiety and depression. So the emerging data suggests treating sleep problems can be an effective means to reduce symptoms.

So where do we go from here? It is now abundantly clear that sleep problems in mental illness is not simply the inconvenience of being unable to sleep at an appropriate time but is an agent that exacerbates or causes serious health problems. Understanding the nature of sleep disruption in mental illness, and developing evidence-based therapeutic interventions using cognitive behavioural therapy, appropriately timed light exposure and some exciting new drugs to stabilise circadian rhythms is a major focus of the work currently being undertaken in Oxford.

It is time we began to take seriously the importance of sleep across all sectors of society, and particularly in mental illness. Treating sleep problems in mental illness will not only improve the health and quality of life for countless individuals and their caregivers, but will also have a massive impact on the economics of health care.

Russell Foster, Professor of Circadian Neuroscience , University of Oxford

This article was originally published on The Conversation. Read the original article.

Maternal child health,account for reduced maternal/infant mortality in Rwanda

Maternal, child health campaigns, account for reduced maternal/infant mortality in Rwanda
Health experts affirm that annual maternal, child health campaigns account for remarkably reduced maternal, child mortality in Rwanda and have aided the country to achieve MDGs and of recent DHS.
The national campaigns are carried out twice a year, and health mobilizers team with local leaders to reach out to children and mothers, tutoring on healthier living.
“These events are not meant for beautiful speeches, they build solid foundations for Maternal Child Health improvement,” said UNICEF Representative Martaza Marick, at the recently launched campaign of the kind.
On Monday,The Rwanda ministry of health launched a week long campaign, focused on improving maternal, child health.
The campaign, kicked off in style, in Cyanika Sector, Burera district giving mothers and children free doses of Albendole and vitamin A tablets.
On the campaign agenda is reaching out to mothers and children under five around the country, emphasizing hygiene, nutrition, prevention of diseases like malaria, HIV and malaria prevention and implementing family planning.
“Rwanda’s remarkable achievements in realizing maternal, child health should not give us room to relax. There are still challenges affecting mothers and children and these need to be addressed,” said James Kamanzi, Director-general of Rwanda Biomedical Centre.
“For example, thirty-eight per cent of children below five years face malnutrition,” added Kamanzi.
At the launch, Aime Bosenibamwe, The governor of the Northern Province, called on parents to embrace a balanced diet as the sure way to raise healthy children.
“Fighting malnutrition does not require a big budget. It only requires the will to do it,” advised the governor.
Apart from campaigns, Kamanzi also credited Rwanda for the tremendous initiatives towards ensuring mother/child health.
Among the fruitful strategies is; routine follow-up on pregnant women, free vaccination, protecting unborn babies from contracting the HIV virus and providing ambulance services to mothers.
Meanwhile, different stakeholders tipped parents on life saving health practices.
“Washing hands properly, with soap saves lives of children. Globally thousands of children don’t celebrate their 5th birthday because of diarrhea,” advised The UNICEF representative.
“Washing hands could save 1.7 million children, dying under 5 years, globally owing to diarrhea and pneumonia,” he added.
World Health Organisation (WHO) also tipped Rwandans on making good use of the available vaccination.
“Rwanda ranks first in Africa when it comes to vaccinating against killer diseases. Research shows that polio, measles are still problems in some African countries but not Rwanda,” said an official from WHO.
Source: www.moh.gov.rw

BINAGWAHO wins 100000$ Roux Prize

Dr. Agnes Binagwaho, Rwanda’s minister of health has won the Roux Prize, for turning evidence into health impact, rebuilding Rwanda’s health system and creating initiatives to improve indoor air quality and combat neonatal deaths.
Binagwaho is the second winner of the Roux Prize, worth a US$100,000 which is given by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and is named for founding board member David Roux and his wife, Barbara.
Dr. Binagwaho’s commitment to acting on data has shaped the philosophy of Rwanda’s health ministry.
The health minister regards Global Burden of Disease (GBD) data as a universal language for policy decision-making in the health sector. “We can see by studying those GBD figures where the next problem is – and we can start to work on it,” she maintains.
Her work was part of a wider effort led by the government of Rwanda to rebuild the country from the ground up and ensure that even the poorest citizens could receive health care.
Along with Dr. Bingawaho, more than 20 Rwandans now collaborate on the GBD study.
“The Global Burden of Disease, by creating and generating data, helps us understand where we need to invest the next dollar, the next effort, the next education initiative,” said Dr. Binagwaho.
Dr. Binagwaho has overseen a remarkable improvement in the health of Rwandans. GBD data revealed that between 1990 and 2013, Rwandan life expectancy increased by about 15 years for both men and women, one of the strongest increases of any country in the world.
Healthy life expectancy has also risen dramatically, by roughly 12 years for both sexes since 1990. Much of this improvement can be mapped directly to policies and investments that Dr. Binagwaho has instituted.
For example, after looking at GBD estimates and finding that household air pollution was the leading risk factor for premature death and disability in the country, Rwanda started a program to distribute 1 million clean cookstoves to the most vulnerable households.
“Whether you are in the capital of Kigali or out in a rural hospital, health policy decisions are being made based on data in Rwanda,” said Tom Achoki, IHME Director of African Initiatives. “The Honorable Minister has made it a priority not only to educate the Ministry in how to produce and analyze quality data, but how to use data to effectively and efficiently overcome Rwanda’s health challenges.”
“In the course of her work leading Rwanda’s health policy and planning, Honorable Minister Binagwaho has come to embody what Dave and Barbara Roux had in mind when they conceptualized the Roux Prize: using rigorously derived evidence to improve health in her community,” said Dr. Christopher Murray, Director of IHME and co-founder of GBD.
“Dr. Binagwaho is not just using disease burden data to improve health – she and her staff at the Ministry of Health are committed to making the Global Burden of Disease study stronger and more useful by vetting its results and addressing data gaps.” said Dr Murray.
From www.newsofrwanda.com

Seven worth knowing about mosquitoes

Seven things worth knowing about mosquitoes

Leo Braack, University of Pretoria

This article is part of a series The Conversation Africa is running as part of the South African Development Community malaria week. You can read the rest of the series here.

1. Not all mosquitoes bite.

The female mosquitoes are the dangerous ones. They bite and draw blood. Male mosquitoes feed on flower nectar. Males have very hairy and fuzzy antennae (like a powder puff) whereas females have less hairy antennae.

2. There are three types of malaria carrying mosquitoes.

The top three malaria transmitters in Africa are Anopheles gambiae, Anopheles funestus and Anopheles arabiensis. The first two live in areas of Africa where there is higher rainfall while the third, Anopheles arabiensis, is a more savanna-based, arid zone species.

Gambiae and funestus prefer to feed indoors and are strongly attracted to humans, but arabiensis feeds as easily outdoors as indoors and also as easily on cattle and other animals as humans. This means it is easier to target gambiae and funestus using indoor methods such as spraying walls with insecticides and using insecticide-impregnated bed nets. The outdoor-feeding arabiensis is far more difficult to control.

In most areas all three species have a peak of biting in the early hours of the morning when people are in their deepest sleep and less likely to disturb mosquitoes during the feeding process. There are also other important species of malaria-transmitting mosquitoes but they are more localised in distribution.

3. Mosquitoes have started to change their feeding patterns.

Because of the strong focus on indoor strategies to fight malaria transmitting mosquitoes using bed nets and indoor spraying, genetic selection is resulting in some populations of these mosquitoes biting outdoors and earlier at night when people are not protected by bed nets. It means these mosquitoes are more difficult to reach with insecticides, just as is the case with Anopheles arabiensis.

4. Most mosquito bites are harmless. It’s only the ones that carry certain types of parasites that lead to malaria, and potentially death.

In Africa, there are four known species of microscopically small parasites that can cause the disease we call malaria. All four belong to the group Plasmodium. The most common of these parasites in Africa is Plasmodium falciparum, which is the most deadly of the four species.

Birds and some other groups of animals carry their own species of Plasmodium, which is also transmitted by mosquitoes, but they do not cause malaria in humans. Mosquitoes also carry many other disease-causing organisms such as yellow fever virus, West Nile virus, Rift Valley fever, and the worms that cause the dreaded disfiguring elephantiasis (filariasis).

5. Mosquitoes select where they feed on the body. They have very acute sensory mechanisms (like heat-seeking missiles) that lead them to select particular parts of the body (such as ankles) to feed from.

All three of the main malaria carrying mosquitoes have similar biting preferences. If you are sitting or standing outside in the evening the overwhelming majority will try to feed on your ankles and feet – so make sure you cover these areas with repellent or wear socks and shoes.

The antennae of mosquitoes are highly specialised sensory organs that can detect very small amounts of chemical cues that lead them to food and mates. Various chemicals, of which carbon dioxide is one, help female mosquitoes track down their hosts. Pheromones, which are hormones secreted as odours into the environment, enable males and females to meet and mate. They are also detected by the antennae.

6. Malaria mosquitoes do not like wind.

Using a fan over you when going to bed will lessen your chances of being bitten. These mosquitoes don’t like flying when there is even a slight breeze.

7. 97 countries and territories still face ongoing malaria transmission.

According to the World Health Organisation, an estimated 3.2 billion people, or just under half the world’s population, are at risk of getting malaria. The bulk of the malaria burden is shouldered by Africa where 89% of cases and 91% of deaths occur.

Leo Braack, Research Chair, Integrated Vector Management in the Vector Control Cluster, Centre for Sustainable Malaria Control , University of Pretoria

This article was originally published on The Conversation. Read the original article.

Cancer and meat-too much hype?

Cancer and meat – too much hype?

Nicolette Hall, University of Pretoria and Hester Carina Schönfeldt, University of Pretoria

The World Health Organisation’s report warning of the link between processed meat and an increased cancer risk has taken the globe by storm and resulted in a flurry of overwhelmingly negative publicity around meat and meat products.

According to the International Agency for Research on Cancer, every 50 gram portion of processed meat eaten daily increases the risk of bowel cancer by 18%. The panel ranked red meat lower, evaluating it as probably carcinogenic to humans, possibly causing bowel cancer.

The International Agency for Research on Cancer is part of the World Health Organisation. Its mission is to co-ordinate and conduct research on the causes of human cancer, the mechanisms of carcinogenesis, and to develop scientific strategies for cancer control. Although the report published a review of scientific findings, it has nevertheless led to misleading reports.

A problematic study

The agency represents the opinion of a selected group of 22 scientists from ten developed countries including Australia, the US, Sweden, Belgium, France and the Netherlands. Its evaluation did not introduce any new evidence. It was based on existing scientific literature, and the opinion it offered is not based on consensus in the global scientific community.

There are two key issues around process that we believe weaken the agency’s findings. The two are: majority agreement on the findings, and that a hazard – and not a risk – assessment was done.

The final classifications were based on a majority agreement and not on unanimous consensus of all members of the working group. These types of evaluations are historically based on unanimous consensus.

Also, the agency conducts hazard analyses, not risk assessments. This distinction is important. It means that for this case study, it considered whether meat at some level, under some circumstance, could be a hazard. Each substance is classified according to its potential hazard. Processed meat has been placed in Group 1: carcinogenic to humans along with tobacco. Red meat has been placed in Group 2A: probably carcinogenic.

Since the 1970s, the agency has reviewed more than 900 products, substances and exposures. More than 400 have been identified as carcinogenic, probably carcinogenic, or possibly carcinogenic to humans.

However, frequency, intensity and potency of exposure to any hazard plays a large role in determining the potential risk. The IARC’s report has published a risk for processed meat. It warned against the risk of eating 50 grams of processed meat each day – the equivalent of two slices of ham – saying it could increase the risk of colorectal cancer by 18%.

Cancers are among the leading causes of morbidity and mortality worldwide, with about 14 million new cases and 8.2 million cancer related deaths in 2012. Nearly one million cancer deaths per year are attributed to tobacco smoking while 600,000 cancer deaths each year are as a result of alcohol consumption. Another 200,000 cancer deaths a year are as a result of air pollution.

The most recent estimates by the Global Burden of Disease Project show that across the globe, 34,000 cancer deaths per year are attributed to diets containing high intakes of processed meat.

In this context, the amount of cancer-related deaths attributed to excessive consumption of processed meats compared to other hazards are relatively small.

Quantifying the estimates further mean that increasing your risk by 18% when consuming more than 350 grams of processed meat per week, you increase your chance to develop colorectal cancer from 56 in 1000 to 66 in 1000.

The agency is not saying that processed meat is as dangerous as smoking. The risk from processed meat and red meat remains smaller than tobacco smoke, alcohol consumption and air pollution.

Down this road before

It is not the first time a misleading message has put into the public domain.

In 1995, the UK Committee on Safety of Medicines issued a warning that oral contraceptive pills increased the risk of potentially life-threatening thrombosis twofold.

The news provoked great anxiety and many women stopped taking the pill. This led to unwanted pregnancies and nearly 13,000 additional abortions in the next year in England and Wales.

Yet, when this daunting “twofold risk” was investigated it was revealed that the incidence of thrombosis had increased from one in 7000 women who did not take the pill to two in 7000 women who do.

A balanced diet

After the International Agency for Research on Cancer released the report, the assistant director-general of the World Health Organisation, Oleg Chestnov, announced that some foods needed to be limited as part of a healthy diet but did not need to be eliminated:

He said the document linking red meats to cancer was aimed mainly at politicians, so that they can regulate the sector appropriately within their borders.

Most governments throughout the world promote balanced approaches to diets based on scientific evidence. They encourage moderate consumption of foods from all the food groups.

This is the sensible approach. Scaring people is not.

Nicolette Hall, Researcher in Human Nutrition, University of Pretoria and Hester Carina Schönfeldt, Associate Professor of Human Nutrition at the Institute of Food, Nutrition and Wellbeing, University of Pretoria

This article was originally published on The Conversation. Read the original article.

Starving cancer cells of sugar could be the key to future treatment

Concetta Bubici, Brunel University London and Salvatore Papa, Birkbeck, University of London

All the cells in our bodies are programmed to die. As they get older, our cells accumulate toxic molecules that make them sick. In response, they eventually break down and die, clearing the way for new, healthy cells to grow. This “programmed cell death” is a natural and essential part of our wellbeing. Every day, billions of cells die like this in order for the whole organism to continue functioning as it is supposed to.

But as with any programme, errors can occur and injured cells that are supposed to die continue to grow and divide. These damaged cells can eventually become malignant and generate tumours. In order to avoid their programmed cell death in this way, cancer cells reorganise their metabolism so they can cheat death and proliferate indefinitely.

Cancer researchers have known for decades that tumours use a faster metabolism compared to normal cells in our body. One classic example of this is that cancer cells increase their consumption of glucose to fuel their rapid growth and strike against programmed cell death. This means that limiting glucose consumption in cancer cells is becoming an attractive tool for cancer treatments.

A new hope?

You may have seen articles or websites advocating that starving patients of sugar is crucial for getting rid of tumours or that eating less sugar reduces the risk of cancer. The story is not that simple. Cancer cells always find alternatives to fuel their tank of glucose, no matter how little sugar we ingest. There is not a direct connection between eating sugar and getting cancer and it is always advisable to talk to your doctor if you have doubt about your diet.

Chemotherapy – the most common cancer treatment.
www.shutterstock.com

Researchers have demonstrated that cancer cells use glucose to generate the building blocks of the cellular compounds needed for rapid tumour growth. They also use it to generate molecules that guard against the toxic accumulation of reactive oxygen species, the cell-damaging molecules that activate programmed cell death. This means that glucose serves as a master protector against cell death.

If the amount of sugar we eat doesn’t affect this process, the question we need to answer is how the cancer cells are instructed to consume more glucose. Who is filling the fuel tank? We have discovered that what allows tumours to evade their natural cause of death in this way is a protein that is overproduced in virtually every human cancer but not in normal cells.

Turbocharged growth

In a recent study published in Nature Communications we showed that cancer cells stimulate the over-production of the protein known as PARP14, enabling them to use glucose to turbocharge their growth and override the natural check of cell death. Using a combination of genetic and molecular biology approaches, we have also demonstrated that inhibiting or reducing levels of PARP14 in cancer cells starves them to death.

The best news is that by comparing cancer tissues (biopsies) from patients that has survived cancer and those that have died, we have found that levels of PARP14 were significantly higher in those patients that have died. This means that levels of PARP14 in cancer tissues could also predict how aggressive the cancer would be and what the chances are of a patient’s survival.

This means that a treatment which could block the protein could represent a significant revolution in the future of cancer treatment. What’s more, unlike traditional chemotherapy and radiotherapy, the use of PARP14 inhibitors would only kill cancer cells and not healthy ones. The next step is to design and generate new drugs that can block this protein and work out how to use them safely in patients.

Concetta Bubici, Lecturer in biomedical science, Brunel University London and Salvatore Papa, Senior scientist, Institute of Hepatology, Birkbeck, University of London

This article was originally published on The Conversation. Read the original article.

Antibiotic overuse might be why so many people have allergies

Avery August, Cornell University

Scientists have warned for decades that the overuse of antibiotics leads to the development of drug-resistant bacteria, making it harder to fight infectious disease. The Centers for Disease Control and Prevention estimates that drug resistant bacteria cause 23,000 deaths and two million illnesses each year.

But when we think of antibiotic overuse, we don’t generally think of allergies. Research is beginning to suggest that maybe we should.

Allergies are getting more and more common

In the last two to three decades, immunologists and allergists have noted a dramatic increase in the prevalence of allergies. The American Academy of Asthma, Allergy and Immunology reports that some 40%-50% of schoolchildren worldwide are sensitized to one or more allergens. The most common of these are skin allergies such as eczema (10%-17%), respiratory allergies such as asthma and rhinitis (~10%), and food allergies such as those to peanuts (~8%).

This isn’t just happening in the US. Other industrialized countries have seen increases as well.

This rise has mirrored the increased use of antibiotics, particularly in children for common viral infections such as colds and sore throats. Recent studies show that they may be connected.

Antibiotics can disrupt the gut microbiome

Why would antibiotics, which we use to fight harmful bacteria, wind up making someone more susceptible to an allergy? While antibiotics fight infections, they also reduce the normal bacteria in our gastrointestinal system, the so-called gut microbiome.

Because of the interplay between gut bacteria and the normal equilibrium of cells of the immune system, the gut microbiome plays an important role in the maturation of the immune response. When this interaction between bacteria and immune cells does not happen, the immune system responds inappropriately to innocuous substances such as food or components of dust. This can result in the development of potentially fatal allergies.

Exposure to the microbes at an early age is important for full maturation of our immune systems. Reducing those microbes may make us feel cleaner, but our immune systems may suffer.

Do more microbes means fewer allergies?

Research done in Europe has shown that children who grow up on farms have a wider diversity of microbes in their gut, and have up to 70% reduced prevalence of allergies and asthma compared to children who did not grow up on farms. This is because exposure to such a wide range of microbes allows our immune systems to undergo balanced maturation, thus providing protection against inappropriate immune responses.

In our attempts to prevent infections, we may be setting the stage for our children to developing life-threatening allergies and asthma.

For instance, a study from 2005 found that infants exposed to antibiotics in the first 4-6 months have a 1.3- to 5-fold higher risk of developing allergy. And infants with reduced bacterial diversity, which can occur with antibiotic use, have increased risk of developing eczema.

And it’s not the just the antibiotics kids take that can make a difference. It’s also the antibiotics their mothers take. The Copenhagen Prospective Study on Asthma in Childhood Cohort, a major longitudinal study of infants born to asthmatic mothers in Denmark, reported that children whose mothers took antibiotics during pregnancy were almost twice as likely to develop asthma compared to children whose mothers did not take antibiotics during pregnancy.

Finally, in mice studies, offspring of mice treated with antibiotics were shown to have an increased likelihood of developing allergies and asthma.

More prescriptions for antibiotics might mean more allergies.
Gary Cameron/Reuters

Why are antibiotics overused?

Physicians and patients know that overusing antibiotics can cause big problems. It seems that a relatively small number of physicians are driving overprescription of antibiotics. A recent study of physician prescribing practices reported that 10% of physicians prescribed antibiotics to 95% of their patients with upper respiratory tract infections.

Health care professionals should not only be concerned about the development of antibiotic resistance, but also the fact that we may be creating another health problem in our patients, and possibly in their children too.

Parents should think carefully about asking physicians for antibiotics in an attempt to treat their children’s common colds and sore throats (or their own), which are often caused by viral infections that don’t respond to them anyway. And doctors should think twice about prescribing antibiotics to treat these illnesses, too.

As we develop new antibiotics, we need to address overuse

As resistant bacteria become a greater problem, we desperately need to develop new antibiotics. The development process for a new antibiotic takes a considerable amount of time (up to 10 years), and drug companies have previously neglected this area of drug development.

Congress has recognized that antibiotic overuse is a major problem and recently passed the 21st Century Cures bill. This bill includes provisions that would create payment incentives from Medicare for hospitals that use new antibiotics.

But this approach would have the perverse effect of increasing the use of any new antibiotics in our arsenal without regard for whether bacterial resistance has developed. This would not only exacerbate the problem of resistance, but potentially lead to more people developing allergies.

Congress should consider more than just supporting increased development of new antibiotics, but also address the core problem of overuse.

This may stave off the further development of antibiotic resistant bacteria and reduce the trend of increasing development of allergies.

Avery August, Professor of Immunology and Chair of the Department of Microbiology and Immunology, Cornell University

This article was originally published on The Conversation. Read the original article.

How music can help relieve chronic pain

Don Knox, Glasgow Caledonian University

As the 17th-century English playwright William Congreve said: “Music has charms to soothe a savage breast.” It is known that listening to music can significantly enhance our health and general feelings of well-being.

An important and growing area of research concerns how music helps to mitigate pain and its negative effects. Music has been shown to reduce anxiety, fear, depression, pain-related distress and blood pressure. It has been found to lower pain-intensity levels and reduce the opioid requirements of patients with post-operative pain.

Music has helped children undergoing numerous medical and dental procedures. And it has been demonstrated to work in a variety of other clinical settings such as palliative care, paediatrics, surgery and anaesthesia.

So what makes music so effective at making us feel better? The research has often drawn on theories around how nerve impulses in the central nervous system are affected by our thought processes and emotions. Anything that distracts us from pain may reduce the extent to which we focus on it, and music may be particularly powerful in this regard. The beauty is that once we understand how music relates to pain, we have the potential to treat ourselves.

Music attracts and holds our attention and is emotionally engaging, particularly if our relationship with the piece is strong. Our favourite music is likely to have stronger positive effects than tracks we don’t like or know. Researchers have demonstrated that the music we prefer has greater positive effects on pain tolerance and perception, reduces anxiety and increases feelings of control over pain. In older people with dementia, listening to preferred music has been linked with decreasing agitated behaviour.

Alongside the benefits of listening to what you prefer, the nature of the music has also been shown to be important in enhancing how emotionally engaging it is for patients. Recent research has demonstrated this in relation to dynamics, brightness, arousal levels and other acoustic attributes. Music which is bright, with low intensity and slower tempo has been shown to have the most positive effect on the degree of pain that we experience, for example.

The pain barrier

On the back of all these insights, we are beginning to see music therapy for pain related to a wide variety of medical conditions. Types of therapy include playing musical instruments, singing and listening to music, though mostly in a clinical setting. Yet despite what we have learned and what we are now beginning to practice, there has been little work on chronic pain. This area of growing importance refers to pain either from an ongoing disease or that continues beyond the normal time that a wound usually takes to heal. This affects more than 14m people in England alone – around a quarter of the population.

To ease the burden on health professionals, the government wants sufferers to increasingly manage their pain themselves. Known as self-management in the jargon, this traditionally includes taking medication, stretching, relaxation exercises and so forth. Music has been suggested as an attractive addition to the list, given that it is inexpensive, can be tailored around the everyday activities of the individual and has few of the negative secondary effects associated with many prescription drugs. Beyond the pain itself, it also has the potential to help with persistent parts of the pain cycle such as stress and negative thoughts – particularly in this era of ubiquitous portable playing devices.

Doctors’ notes?
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There is also much to study, however. We may know that the music we like can help with the negative symptoms of pain, but key mechanisms are still not fully understood. If being emotionally engaged with music is key to maximising our distraction in this regard, there are myriad factors affecting our emotional relationship with music that we need to understand.

These include the personal meaning and memories that the music conjures for a particular individual, the context the listener is in and factors such as age, gender, occupation and identity. There’s also a lot we don’t know about how people use music to regulate their emotions, such as using it to achieve a psychological high or to suppress negative feelings. Insights into these areas won’t only help in relation to chronic pain, but would certainly bring important benefits in that area.

Most of the research to date has been in laboratories and clinical settings – hence the reason most therapy takes place in the presence of specialists. Particularly if we are to learn how best to apply music to chronic pain, where self-management is so important, we’re going to need more research situated in everyday settings.

I am planning studies myself based around everyday music listening and how this can help support self-management of pain. Undoubtedly music therapy for chronic pain is an area with great potential, so there is every reason to others to press ahead too.

Don Knox, Senior audio lecturer, Glasgow Caledonian University

This article was originally published on The Conversation. Read the original article.